Last updated on September 6th, 2023 at 01:42 pm
Since it is September, I thought I would provide some updated information about getting the RSV, COVID-19, and flu vaccines this fall. Can you take them together? If not, what should be the timing?
I think there is some misinformation out there, and of course, certain groups are probably making up all kinds of nonsense about these vaccines, 99.99% of which are untrue. I’ll stick to the facts about these vaccines.
What are the RSV, COVID-19, and flu vaccines?
Although most people know about these vaccines, the RSV vaccine is a newcomer since it was only approved in July 2023.
The respiratory syncytial virus is a common, contagious virus that causes respiratory tract infections. It is a single-stranded RNA virus, and its name is derived from the large cells known as syncytia that form when infected cells fuse.
It usually causes mild, cold-like symptoms. But it can cause severe lung infections, especially in infants, older adults, and people with serious medical problems. For seniors, RSV infections are dangerous as their immune systems weaken.
RSV spreads from person to person through:
- The air by coughing and sneezing.
- Direct contact, such as kissing the face of a child who has RSV.
- Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands.
RSV can sometimes lead to pneumonia (infection of the lungs) and congestive heart failure (when the heart can’t pump blood and oxygen to the body’s tissues).
According to the CDC, each year in the United States, RSV leads to approximately—
- 2.1 million outpatient visits among children younger than 5 years old
- 58,000 hospitalizations among children younger than 5 years old
- 177,000 hospitalizations among adults 65 years and older
- 14,000 deaths among adults 65 years and older
The RSV vaccine is approved and recommended for adults 60 years or over. There are two versions of the RSV vaccine — Arexvy from GSK and Abrysvo from Pfizer.
There is also a pediatric RSV vaccine recently approved by the FDA and recommended by the CDC for all infants under the age of 8 months. The CDC is also recommending the vaccine for children between the ages of 8 and 19 months who are at increased risk of severe RSV disease. The vaccine, called Beyfortus, should be widely available this fall.
The seasonal flu vaccine protects against four circulating strains of influenza virus — an influenza A(H1N1) virus, an influenza A(H3N2) virus, and two influenza B viruses. Despite the claims of some people, the CDC estimates that approximately 12,000 – 52,000 deaths occur annually from flu between 2010 and 2020. And not all of those who are harmed are elderly or children, during some flu pandemics, healthy adults are killed.
The seasonal flu vaccines (depending on the version) should be given to anyone older than 6 months. For people 65 years and older, there are three flu vaccines that are preferentially recommended over standard-dose, unadjuvanted flu vaccines.
Finally, we need to discuss the COVID-19 vaccines. There are three versions available:
- The Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines. Just to be clear, the mRNA vaccines are safe and they do not interact with the DNA of any human.
- The Novavax COVID-19 vaccine is a more traditional protein subunit vaccine.
- The J&J/Janssen COVID-19 vaccine, a viral vector vaccine is no longer available for use in the United States as of 6 May 2023.
According to the CDC, the vaccine schedule for the current, updated Pfizer-BioNTech or Moderna vaccines is complicated:
- Everyone six years or older should get the updated vaccine.
- People 65 years or older may need two doses of the updated vaccine.
- Children ages six months through five years may need multiple doses of the updated vaccine, depending on how many doses they had previously.
Also according to the CDC, the vaccine schedule for the Novavax COVID-19 vaccine is similarly complex:
- This vaccine is only indicated for individuals 12 years and older.
- Two doses are recommended, 3-8 weeks apart.
- A third dose, preferably the Pfizer-BioNTech or Moderna vaccines, is recommended two months after the second dose of the Novavax vaccine.
Timing of the flu, RSV, and COVID-19 vaccines
Depending on one’s age and health, individuals will need to determine which of the vaccines they should get. Based on the information I wrote above about the CDC recommendations if you are over the age of 60, the recommendation is rather straightforward — get the seasonal flu, RSV, and updated COVID-19 vaccines.
Also based on what I wrote above, for children under the age of eight months, it gets a little complicated — get the RSV vaccine if the child is under eight months, the flu and updated COVID-19 vaccines for children if the child is between six and eight months.
And again based on what I wrote above, anyone older than eight months through 60 years old should get the flu and COVID-19 vaccines, unless there is a medical reason for getting the RSV vaccine.
For individuals younger than 65 who have chronic medical conditions (diabetes, cancer, respiratory disease, and many others), are immunocompromised, or are pregnant, the COVID-19 and seasonal flu vaccines are recommended.
There is plenty of evidence that the flu and COVID-19 vaccines can be taken together, and since they are available now, go for it.
Now it gets a bit complicated. There is no good evidence available as to whether the RSV vaccine can be taken with the other two vaccines. Plus, a lot of people are not going to be thrilled to get three shots at the same time. (As an aside, I had to travel to Brazil a few years ago, and the company I worked for at the time required that I get several vaccines for the trip — hepatitis A & B, yellow fever, typhoid, tuberculosis, and up-to-date on all other adult vaccines. I believe I got six vaccines at once, and despite being solidly pro-vaccine, I will never make that choice again.)
I don’t see much consensus as to whether anyone over the age of 60 gets one, two, or three vaccines at once. I guess I would get all three at once, despite my previous experience with multiple vaccines, but I’d rather just make one trip to my physician.
I want to be very clear about something — there is no evidence that these vaccines have serious side effects, despite the irrational claims on the internet. And all three protect against dangerous diseases that can kill people, especially seniors and young children. And if you’re around seniors and young children, even if you are perfectly healthy, you should strongly consider getting the vaccines to protect your friends and family.
Vaccines save lives.
